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Autotransplant in Multiple Myeloma with Oral Melphalan, without Cryopreservation

Uendy Perez Lozano, Jose Luis Ruiz Ovalle, Jose Alejandro Limon Flores and Ruben Daniel Lobato Tolama

Multiple Myeloma (MM) is the second most frequent hematologic cancer in adults with a marked increase in incidence; therefore, the costs related with the treatment are considerable in all the health systems worldwide. Pharmacological developments have made of Myeloma a chronic, yet incurable, disease. Hematopoietic transplantation is still essential for controlling this disease. The strategies for reducing costs without decreasing the therapeutic efficacy are very important for health systems as they increase the efficiency of the procedure.
Purpose: To retrospectively describe evolution of patients with MM treated with hematopoietic transplantation at Hospital de Especialidades of the Mexican Social Security Institute in Puebla, Mexico.
Material and Methods: Out of 388 transplants performed without cryopreservation, 22 patients with MM were analyzed, all of them mobilized without chemotherapy, only with filgrastim. Cell harvests were performed at 4°C, within 4-6 days. Conditioning prior to hematopoietic autotransplant (HAT) was oral melphalan at 225 mg/m2 in 77% of the cases. Three patients received allogenical transplant after the autologous transplant.
Results: Twenty-two HAT were performed in that many patients. Three of them later received an allotransplant due to a compatible related HLA donor. Sixty-eight percent (15) were men and 31% (7) women, between 29-57 years old, with a mean age of 44.4 years. An average of 1.5x106 CD34+ cells/kg with a range of 0.5-4.0×106/kg and an average viability after refrigeration of 90%. The average number of days in hospital was 29.2. The average number of days for obtaining neutrophilic graft (>500/mm3) was 12.3, 18.9 for effective erythropoiesis, and 20.3 days for effective plateletpoiesis. Mortality for autotransplant was 0%. With an 87-month follow-up, 8 patients (36.3%) remain in complete response (CR), 7 (31.8%) in very good partial response (VGPR), and 4% (18.1) in progressive disease (PD). The autologous post-transplant progression rate was 36.3%. Time to progression was 64.3 months in average. Overall survival of the series was 86.4%.
Conclusions: HAT can be performed safely even without cryopreservation of autologous hematopoietic cells.